A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward.
BACKGROUND: Patients are at risk for respiratory complications after sustaining blunt chest trauma, yet contradictory evidence exists about the utility of prophylactic respiratory therapy to reduce respiratory complications in this population. This study assessed the effectiveness of a proactive res...
| Publicado en: | Respiratory Care Vol. 61; no. 12; pp. 1580 - 1588 |
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| Autores principales: | , , , , , , |
| Formato: | algorithm CEU research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Dec2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119931138&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 119931138 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Dec2016 vid: 61 iid: 12 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 119931138 119931138 119931138 10.4187/respcare.04729 119931138 ppf: 1580 ppct: 8 formats: fmt: @attributes: type: P tig: atl: A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward. aug: au: Nyland, Bethany A. Spilman, Sarah K. Halub, Meghan E. Lamb, Keith D. Jackson, Julie A. Oetting, Trevor W. Sahr, Sheryl M. affil: General Surgery Residency Program, Iowa Methodist Medical Center, Des Moines, Iowa sug: subj: Trauma Complications Respiratory Failure Prevention and Control Protocols Human Inpatients Treatment Outcomes Retrospective Design Kruskal-Wallis Test Pearson's Correlation Coefficient Post Hoc Analysis Matched-Pair Analysis Two-Tailed Test Descriptive Statistics Data Analysis Software Male Female Middle Age Aged Algorithms Record Review Pretest-Posttest Design Education, Continuing (Credit) Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: Patients are at risk for respiratory complications after sustaining blunt chest trauma, yet contradictory evidence exists about the utility of prophylactic respiratory therapy to reduce respiratory complications in this population. This study assessed the effectiveness of a proactive respiratory protocol on an in-patient ward to identify trauma patients at risk for pulmonary complications, administer appropriate therapies, and prevent deterioration requiring transfer to the ICU. METHODS: Trauma patients received a respiratory therapy evaluation at the time of admission to a general in-patient ward at a Level 1 trauma center. If subjects met protocol inclusion criteria, they received prophylactic respiratory treatments, primarily MetaNeb therapy, Vest therapy, or EzPAP. Multiple phases were included to evaluate the effectiveness of the protocol, with 50 subjects in each phase: a pre-protocol phase before adoption of the protocol; phase 1, which was found to have low physician adherence and overly broad inclusion criteria; and phase 2, with improved adherence and narrower inclusion criteria. Study inclusion criteria mirror the protocol criteria from phase 2: ≥3 rib fractures; pulmonary contusion; exacerbation of COPD, asthma, or other lung disease; or age ≥65 y with expected immobility of ≥48 h. RESULTS: The respiratory protocol was associated with an elimination of unplanned admissions to the ICU. After controlling for injury severity and other important clinical factors, receiving the protocol significantly decreased hospital stay by approximately 1.5 d. More subjects were admitted from the emergency department directly to the ward, avoiding the ICU. Bronchodilator use also decreased, although the result did not reach statistical significance. CONCLUSIONS: Study results suggest that a preventive respiratory protocol had a beneficial effect on patient outcomes; receiving the protocol reduced hospital days and eliminated unplanned admission to the ICU. pubtype: Academic Journal doctype: algorithm CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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